Posted October 05, 2011

Are you holding leaders accountable for only 1/8 of the HCAHPS pie?

By Penelope Elebash

As healthcare organizations shift to the new reality of value-based purchasing (VBP), HCAHPS results become more and more critical. Not only are results directly connected to Medicare (and increasingly private payer) reimbursement, they reflect the quality of the care you provide and serve as a barometer that demonstrates your organization's commitment to excellent patient care.

As we coach organizations across the country, we find many have already made the switch to measuring patient perception of quality solely on HCAHPS metrics. We also find that accountability is the key to doing it well. Successful organizations create focus and instill a sense of urgency by building and weighting goals around HCAHPS results into leader evaluations.

So what can you do to maximize HCAHPS results in your organization? First, make sure you're taking all HCAHPS components into account.

We see some organizations measuring leaders on a single HCAHPS composite: overall rating. The habit of zeroing in on a single survey item is likely a natural evolution from the days when inpatient satisfaction ruled—when high "likelihood to recommend" was considered the best gauge of customer satisfaction and loyalty. But with the advent of HCAHPS, many organizations are finding this "single item" approach may not achieve the desired results.  

If you're focusing only on the "overall" rating, or any one composite, you are holding your team responsible for just 1/8 of its HCAHPS potential. In terms of reimbursement, all HCAHPS composites are created equal.

If you're below the floor in even one composite, you'll automatically lose 20 points for consistency in your reimbursement calculation. And if you're above the floor but below the 50th percentile you'll lose anywhere from 1 to19 points. This is why it's important to set goals that create urgency for your leadership team to achieve results above the 50th percentile in all eight composites.

One of the biggest shifts in setting metrics this way will take place in your approach to organizational and senior executive goals. One option is to look simply at the number of composites over the achievement or benchmark parameters. If there are eight total composites, the goal may state "Achieve 6/8 composites at benchmark or higher." On a five-point scale, hitting 6/8 would equal the three level, and exceeding to hit more composites at benchmark or better would be the four and five levels of achievement. Another option is to look at the total value of the top box "points" for the eight composites used in the VBP calculation. This is a simple calculation that captures all the elements and takes into account the rate of improvement across composites. 

Once senior goals are set, cascading them becomes critical to maximizing HCAHPS performance: not every leader will carry the same goals, but certainly those that influence certain composites may carry heavier weight on the evaluation to move those results.  Make sure leaders have some "skin in the game." Identify which areas of your organization significantly impact any HCAHPS composite results that fall below the 50th percentile line and align leader evaluations in a way that will move those results. To create urgency, you'll want to assign those leaders' goals a weight of at least 30 percent.

Remember, what we measure—and what we hold people accountable for—is what gets done. It's really that simple. We find organizations sustain results when objective, weighted metrics represent the leader's full evaluation. In addition to HCAHPS goals, leaders should also be accountable for weighted metrics across Quality, Finance, Growth, and People—the metrics underneath each of these categories will align to your organization's desired movement in a fiscal year. An organization can have great tactics and great leader training in place, but if it's missing the accountability piece of the equation, the other pieces won't sustain the gain.

It's not always easy to make sure the right leader has the right goal with the right weight. But it's worth the effort to get this right because it impacts the quality of care we provide. When an organization gets to the point that leaders are consistently meeting goals and moving results upward, patient care will get better and better...and that's the why behind everything we do.


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